Individual
STEPHANIE K FENNEMA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
3813 OLD PORT ROYAL RD N, SPRING HILL, TN 37174-2813
(931) 487-1006
Mailing address
4106 COLUMBIA ROAD, SUITE 103, MARTINEZ, GA 30907
(706) 863-1440
(706) 863-5418
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
005416
GA
363A00000X
Physician Assistant
Primary
3168
TN
363A00000X
Physician Assistant
PAT 9103434
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
292261400
—
FL
01
—
U6631
BCBS FL
FL
Enumeration date
06/24/2006
Last updated
02/11/2025
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